Part 1 The Tour You are an intern working in the Atlanta, GA office of Dr. Priya Wayne, MD. Dr. Wayne is a specialist in

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Part 1 The Tour You are an intern working in the Atlanta, GA office of Dr. Priya Wayne, MD. Dr. Wayne is a specialist in rare neuromuscular and musculoskeletal disorders. You've been working with Dr. Wayne for the last year and due to this experience you've gained a great deal of knowledge about the human body and muscle physiology. You're also a college student and working with Dr. Wayne has allowed you to gain first-hand experience with some of the material that you're learning in your human physiology course. Just last week you had to turn in an assignment comparing and contrasting disorders of the neuromuscular junction. You learned all about several issues, including myasthenia gravis, sarin, curare, botulism, and Eaton-Lambert syndrome. Today a group of high school students is coming for a tour and Dr. Wayne has asked you to prepare some information about muscles to present to the students. Specifically, Dr. Wayne has asked you to discuss the neuromuscular junction (NMJ), skeletal muscle contraction, and explain some of the issues that can occur when signaling between neurons and muscles does not go as planned. Questions Use the word bank to match the appropriate letter to the definitions/descriptions on the next page. (a) Sodium (b) Nicotinic acetylcholine receptor (nACh) (c) Myosin (d) Actin (e) Acetylcholine (ACh) (f) Depolarization (g) Motor end plate (h) Acetylcholinesterase (ACE) (i) Synaptic vesicles (j) T-tubule (k) Sarcoplasmic reticulum (1) Dihydropyridine receptor (m) Ryanodine receptor (n) Synaptic terminal (o) Sarcolemma (p) Sarcomere
After the high school group finishes their tour, Dr. Wayne sees two patients. Jeff Slater is a biochemist working for a biowarefare lab at the CDC. He is currently working on a project to develop a new neurotoxin and is using sarin as a model substance. Suddenly while working the lab alarms go off and Jeff accidentally knocks a vial of sarin over and a bit of the liquid splashes onto his arm between his gloves and lab coat. He suddenly starts to feel dizzy, his heart starts pounding harder than ever, and he has shortness of breath. He feels incredibly sluggish and tries to get to the exit. As he approaches the lab door, his muscles cramp up and he falls down and hits his head, knocking him unconscious. His colleague from across the hall happens to see him fall and calls for help. Jeff is given oxygen and taken to the nearby hospital, which happens to have a neuromuscular specialist. The sounding of the alarm turns out to have been just routine testing of a new system. Questions 1. What symptoms is Jeff experiencing? 2. What is the role of AChE in the NMJ? Jeff is admitted to the hospital and Dr. Wayne examines him. Jeff is unconscious but seems to be experiencing some paralysis, so Dr. Wayne orders blood work. Results are listed below. J. Slater-Test Results Blood Pressure Hematocrit (%) Glucose (mg/dl) Sodium (mmol/L) Test Potassium (mmol/L) ACHE Activity Test (9) Tetralodothyronine or thyroxine (T) ing/dt.) Serum Triiodothyronine (T) (ng/d) Result 105/65 37.5 88 139 3.8 44 9.1 112 Normal Range 90-120/60-80 36-38 70-110 135-145 3.5-5.0 100 46-12 80-180
Part III-Sandy Thompson A 25-year-old preschool teacher, Sandy Thompson, has not been feeling like herself lately. She has been feeling quite tired and her co-workers have commented on her droopy eyelids. Additionally, she is experiencing weakness in her arms and legs, has difficulty talking clearly and even her students' parents have been concerned that Sandy hasn't been looking very happy at work. One day at lunch, Sandy started to choke on her food, causing one of her coworkers to perform the Heimlich maneuver on her. While the scare didn't cause any permanent damage, Sandy is convinced that it is time to go see a doctor. When she finally arrives at her appointment with Dr. Wayne, she explains to Dr. Wayne what has been going on, and the doctor decides to run a few blood tests. Sandy's blood work results are presented below. S. Thompson-Test Results Test Blood Pressure Hematocrit (%) Glucose (mg/dl) Sodium (mmol/L) Potassium (mmol/L) ACHE Activity Test (9) Tetraiodothyronine or thyroxine (T) (ng/dL) Serum Triodothyronine (T) (ng/dl) Antibodies for ACh Receptors Result 115/73 36.5 94 144 4.3 100 11.3 154 Present Normal Range 90-120/60-80 36-38 70-110 135-145 3.5-5.0 100 4,6-12 80-180 Not Present.
What are Jeff's symptoms? 2 B IU A ▼ A TEE Y X X E15pt 2 points What is the role of acetylcholinesterase in the neuromuscular junction?
4 Which of Jeff's lab tests are abnormal? 5 BIUA Y A Y 2 points What is the mechanism of action of sarin? BIUA A LE x x E 15pt Y IEEE X X EE 15pt Paragraph Paragraph 2 points How would exposure to sarin affect the amounts of sodium entering the muscle cell? Why?
7 How would exposure to sarin affect the calcium levels inside the sarcoplasmic reticulum? Why? 8 BIU А Т ALEEEE 15pt BIUA- ▼ Paragraph 3 points How would these altered calcium levels affect the sarcomere (position of the actin and myosin filaments)? Why? IEEE xx, E15pt EEE Paragraph 6 DL fr 2 points What needs to happen to Jeff's post-synaptic membrane to remedy his paralysis? What does he need more of and where?
What symptoms is Sandy experiencing? BIUA Y B IU A LE3 10 2 points What levels from her blood work are abnormal? IEEE x X X EE15pt EE15pt 11 2 points How would antibodies against ACh receptors affect the neuromuscular junction? Paragraph Paragraph HAI
How would antibodies against the ACh receptors affect the influx of sodium into the cell? BIVALEXEE 15pt 14 B ZU AR-LEIN 3 2 points How would antibodies against the ACh receptors affect the levels of calcium inside the sarcoplasmic reticulum. What effect does this have on the sarcomere (the actin and myosin filaments)? 3 points What is Sandy's diagnosis? Paragraph E15pt Paragraph 8 h H -03 5 -03